April 19, 2010
EMR Technology Exacerbates Problems
Written by: John
One thing that I’ve mentioned many times in the 4+ years of blogging about EMR is the impact of technology on a clinic. I’ve regularly mentioned that you shouldn’t implement an EMR to try and fix process problems in your clinic. Instead, you should first address the process problems in your clinic and then implement the EMR with the proper processes already in place.
The reason for this is quite clear. Technology, in this case EMR, has a tendency to just exacerbate any problems that exist in a clinic. In fact, it will often bring to light problems that you didn’t know existed before EMR.
A simple example is doctors who are behind on their charts. In the paper world, you might not know how far behind they are on their charting. In the electronic world many EMR software make it abundantly clear how many charts still need to be completed.
In a call I had recently with the people behind the Mitochon EMR, they made a really interesting point about communication between doctors. It’s basically the same concept as I’ve described above. If communication between doctors is bad in the current world, then layering some sort of HIE or other technology on top of it will just make communication worse. Technology is going to accentuate and enhance (for good and bad) whatever might be going on currently.
Interestingly, this concept might add further light as to why so many EMR implementations fail. Sometimes it’s hard to look in the mirror for the first time and take a good hard look at what’s really happening in your clinic.
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12 responses to "EMR Technology Exacerbates Problems"
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John,
The issue you bring about inter-doctor communication extends up and down the value chain. Generally, “doctor-to-doctor” communications is continually reinforced while in medical school and in residency. Therefore, the barriers to doctor-to-doctor communications are either artificial, arbitrary or organizational, but certainly not by learning.
I also think that the software process, both development and deployment is also contributing to communications problems (see my two blogs (http://ning.it/avEfAu and http://tinyurl.com/y6pqlkc) The vendors themselves have a difficult problem in both development and sales to achieve a “meeting of the minds” model. They are often not on the same page.
In summary, I think software only formalizes business processes and work flow. If these entities are poorly performed then software does exacerbate the situation.
Richard
Excellent points again John. This post reminded me of the struggles my mother and her colleagues have face in teaching online. Teachers who are more engaging, more interested in helping their students, and generally open to listening to others will attempt to do so regardless of if they’re in the classroom or over the computer. Teachers who are closed, who rely primarily on lecture and don’t engage their students, and who aren’t open to anyone’s opinion but their own will not suddenly become innovate because they’re given new technology to “improve” their classes.
Richard,
Why are you blogging on Ning? Soon you’re going to have to start paying to be on there and the platform isn’t really that great anyway. I do enjoy your insights though. Just wish you were on a better service;-)
Michelle,
Interesting comparison with teaching. I honestly think the principle applies across everything. Like one of my professors use to say, “Technology is where it’s at…Baby!!”
John,
One of the first steps we coach our EMR clients is to successfully manage change. This includes viewing the potholes in your current processes before mapping over to how those processes will be executed in a new EMR system.
The process “potholes” are also a great knowledge improvement opportunity. Successfuly EMR training programs shouldn’t make users system experts; they should empower users to better perform their duties with new systems and solid processes.
Exactly. Potholes just get worse if you don’t fix it before laying road over the top. Same is true with laying an EMR over the top of the clinic.
John, I couldn’t agree with you more. But, if you use the “process mapping” time well before implementation, you can repair the potholes under the guise of the upcoming EMR implementation! ;)
One of the processes I have advised is the WF Kellogg Logic Model for Program Evaluation. If the client knows the outcome desired and then work backwards, it’s possible to consolidate all of the assumptions, expectations and enabling activities necessary to resource and execute on any kind of project
Tony,
Then how will people know if they got any benefit from the EMR or just from the process improvement?
I of course say, “Who cares?” Take all the benefits of EMR both indirect and direct ones.
I worked at Univ of MI hospital on a team that implemented CPOE successfully ’06-08. But it wasn’t easy. Hours of figuring out current workflow and subsets, and synonyms; hours of telling them and showing them what’s coming and how it will help; hours of finding out needs; hours of training; hours of PR/marketing; and hours and weeks of implementation, with hundreds in the units, behind the scenes on computers, making it all come alive. Doctors were upset that they had to input orders and not give orders to nurses; that verbal was for emergence; that phone orders were for out of the hospital; but happy that they could do orders from home on their secure link. The project was built in house w/the U’s own computer teams and w/software creator’s assistance. The tech team is still there working on updates and needs. That is the only way to truely implement successfully-in house team working with the customer, understanding current workflow, finding needs, creating solutions, being there always to help, not dropping the customer once the switch is turned on.
John,
You said “…Then how will people know if they got any benefit from the EMR or just from the process improvement?…”
I think that the customer has to care because funding for these projects is uncertain. In fact, the outcomes and outputs may be the key performance indicators that might determine the value of the deliverables.
On the one hand, the vendor just wants to get the product installed and running and try to fix problems as they come up. They hope that problems won’t crop up in the 1 year proceeding sign off on the project completion because anything after that is extra professional service fees.
Who cares? Of course the funding source cares. All funding sources have accountability processes and a lack of “caring” means that accountability cannot be satisfied.
In summary, we can throw fancy words about this project paradigm and that, but the outcome and the activities necessary to achieve those outcomes should govern any kind of project deliverable. In my opinion, the project is always subservient to the outcome desire.
Joanne,
Great story. I will say that it’s a bit different at a hospital than an ambulatory clinic. Although, the effect of technology on both environments is the same. It’s just how you deal with that effect that’s very different.
Richard,
Certainly they need to care about the return that they’re getting on implementing an EMR. However, should they care whether the benefit came from the workflow process improvements that an EMR implementation analysis brought to light and therefore improved the clinic or from the EMR use itself?